ST complained of a history of minor bleeding from her vagina and an ultrasound scan revealed the presence of a small cyst on ST’s ovary. The treatment plan put in place was for the cyst to be monitored with four monthly repeat scans. These ongoing scans reported that the cyst remained “unchanged”.
After visiting her consultant gynaecologist, ST was reassured regarding her 1.5cm cyst. Despite this, ST was offered laparoscopic surgery to remove the cyst instead of continuing to monitor the cyst with periodical scans. The consultant advised ST that surgery was the preferred treatment choice due to the risk of ovarian cancer associated with her cyst. ST agreed to undergo the surgery due to the warning given to her of being at risk of ovarian cancer in the future.
What went wrong?
ST underwent bilateral salpingo-oophorectomy. During the surgery, ST’s bowel was perforated. Despite this, the operating surgeon did not identify the perforation and ST was then returned to the ward. Shortly after surgery, ST complained of symptoms consistent with a bowel perforation and continued to complain about her symptoms for the next 8 days before a Consultant Physician advised an urgent CT scan.
By this point, ST was very unwell. The CT scan identified a 5mm bowel perforation as being the cause of her symptoms and she then underwent a laparotomy to repair the perforation. ST then had to endure six further laparotomies, all under general anaesthetic to fix the bowel perforation.
ST suffered significant injuries as a result of complications during surgery. She had to return to theatre on numerous occasions and endured a prolonged stay in hospital. Due to the numerous bowel resections, she was left with a short bowel, which caused short bowel syndrome which affected her ability to absorb nutrition.
ST was left with ongoing difficulties with both diarrhoea and constipation. She was left with significant scarring to her abdomen as a result of the numerous surgical procedures. ST also suffered from psychiatric injuries including a Depressive Episode and Depression. ST was likely to remain vulnerable to further episodes of depression, despite the treatment recommended.
ST became reliant on her family for all aspects of care following her discharge. She lost a significant amount of weight and strength and along with the need to be near a toilet due to ongoing difficulties with diarrhoea and lack of energy. She had to change the nature of her work to an office based role in light of her symptoms.
How we helped
At the outset, we requested a copy of the defendant Trust’s Guidelines on the management and treatment of ovarian cysts. The Guidelines highlighted that where an ovarian cyst measures less than 5cm, conservative treatment was necessary. ST was not symptomatic and as she was not actively requesting surgery, our investigations revealed that it was below the reasonable standards of care expected for ST to be offered bilateral salpingo-oophorectomy in the first place.
We obtained a report from a consultant gynaecologist who supported this allegation. The gynaecologist also supported the allegations that whilst it was not below the reasonable standard of care for ST’s bowels to be perforated during surgery, it was unacceptable to fail to recognise the perforation had occurred before ST was sent to the ward and the subsequent delay in recognising that ST’s deteriorating health might have been caused by a perforated bowel.
The above allowed us to present to the defendant a ‘primary’ and ‘secondary’ case: the first, that ST should not have been offered surgery in the first place and has she not undergone surgery, her bowel would not have perforated. In the alternative, if it was found to be acceptable for ST to undergo surgery, there was a failure in not recognising that a perforation had occurred and returning ST to theatre to repair the perforation.
In response to our letter of claim, the defendant conceded breach of duty for the ‘secondary’ case but denied that surgery was unnecessary. We subsequently commenced proceedings. Two days before proceedings were served; the defendant admitted that ST should not have undergone surgery in the first place. Significant damages were obtained for ST’s injuries.